脑脊液MyD88L265P基因突变对原发性中枢神经系统淋巴瘤预后的影响

目的:分析比较脑脊液髓样分化因子88L265P（MyD88L265P）突变和白细胞介素10（IL-10）与原发性中枢神经系统淋巴瘤（PCNSL）预后的关系。方法:收集2013年8月至2016年12月间复旦大学附属华山医院北院经手术或定位穿刺病理确诊的39例初发PCNSL患者（男18例，女21例，年龄40~73岁）的病例...

Prognostic effect of MyD88L265P gene mutation in cerebrospinal fluid in primary central nervous system lymphoma

Objective This study has investigated the value of detecting cerebrospinal fluid(CSF)MyD88L265P mutation and interleukin-10(IL-10)levels in the prognosis of PCNSL.Methods We retrospectively analyzed the clinical data,CSF characteristics(including cytology,cell counting,total protein,and the level of cytokine IL-10)and treatment process of 39 PCNSL patients newly diagnosed by surgery and pathology(18 males and 21 females,aged 40-73 years)from August 2013 to December 2016 in Hua Shan Hospital North.MyD88L265P mutation was detected by digital PCR in 39 paraffin-embedded tissues and 35 cerebrospinal fluid samples.Log-rank test was used for univariate analysis and Cox regression for multivariate analysis to establish the prognosis model of PCNSL which might be related to PCNSL first progress-free survival(PFS)and overall survival(OS).Results The median age of the 39 PCNSL patients was 59 years old,with 30.8%(12/39)intraocular involvement.The mutation rate of MyD88L265P in tissues and cerebrospinal fluid was 74.4%(29/39)and 40.0%(14/35),respectively.51.9%(14/27)patients were observed with MyD88L265P mutation in both tissues and CFS.Univariate analysis showed that intraocular involvement,high level of IL-10 in CFS(≥45 pg/ml),and MyD88L265P mutation in CFS are factors significantly influencing median progression-free survival(mPFS)of patients(P<0.05).Patients with intraocular involvement had shorter OS than those without involvement which was statistically significant(HR=6.5,95%CI 1.7-47.3,P<0.05).And multivariate analysis showed that intraocular involvement(HR=2.4,95%CI 1.3-7.8,P<0.05)and CFS MyD88L265P mutation(HR=2.1,95%CI 1.1-5.7,P<0.05)were independent prognostic factors for PFS.Conclusion The presence of intraocular involvement and MyD88L265P mutation in CFS indicated poor prognosis of PCNSL patients.High CSF IL-10 level was not an independent factor affecting prognosis.